title: Environmental and personal factors that support early return-to-work: a qualitative study using the ICF as a framework.
abstract: BACKGROUND
  Occupational health professionals such as occupational physicians (OPs) increasingly understand that in addition to health improvement, environmental factors (such as work adaptations) and personal factors (such as an employee's attitude towards return-to-work (RTW)) may stimulate employees on sick leave to return to work early. To target their professional interventions more specifically according to these factors, occupational health professionals need further insight into environmental and personal factors that stimulate RTW.
  
  
  OBJECTIVE
  The objectives of this study are (1) to identify which and how environmental and personal factors support RTW, and (2) to examine whether the International Classification of Functioning, Disability and Health (ICF) can be used to describe these factors.
  
  
  METHODS
  We performed interviews with 14 employees, 15 employers and 4 OPs from multiple organisations with varying organisational sizes and types of industry such as healthcare and education. We used a qualitative data analysis partially based on the Qualitative Analysis Guide of Leuven.
  
  
  RESULTS
  The following environmental factors were found to support early RTW: 'social support from relatives', 'belief that work stimulates health', 'adequate cooperation between stakeholders in RTW' (e.g., employees, employers and OPs) and 'the employers' communicative skills'. One personal factor stimulated RTW: 'positive perception of the working situation' (e.g. enjoyment of work). Most factors stimulated RTW directly. In addition, adequate treatment and social support stimulated medical recovery. Environmental factors can either fully (social support, belief that RTW stimulates health), partially (effective cooperation), or not (employers' communicative skills) be described using ICF codes. The personal factor could not be classified because the ICF does not contain codes for personal factors.
  
  
  CONCLUSIONS
  RTW interventions should aim at the environmental and personal factors mentioned above. Professionals can use the ICF to describe most environmental factors.
authors.affiliation: Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
authors.forename: Nicole
authors.initials: N
authors.lastname: Hoefsmit
authors.affiliation: Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Houkes
authors.affiliation: Department of Work and Organisational Psychology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Nijhuis
mesh_terms: D000328:Adult; D001290:Attitude; D003142:Communication; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D007407:Interviews as Topic; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D010465:Perception; D036301:Qualitative Research; D062707:Return to Work; D012944:Social Support; D013997:Time Factors; D017132:Workplace / Q000458:organization & administration / Q000523:psychology
keywords: Sickness absence; qualitative study; return-to-work